Fluoroscopic Control Research Articles

Catheter tip malposition after percutaneous placement of tunneled hemodialysis catheters.

The percutaneous catheterization of central veins is increasingly used in nephrological practice as a temporary or permanent vascular access. The aim of our study was to present and to analyze episodes of catheter tip malposition during percutaneous tunneled hemodialysis catheter insertion in the large, unselected group of patients. All patients who underwent the procedure of catheter insertion in our department during year 2012 were analyzed retrospectively. One hundred four tunneled hemodialysis catheters were inserted in 101 patients. In 58 patients, the catheter was inserted at the initiation of hemodialysis therapy as the first access and in 46 the catheter was placed because of the failure of the existing one. In 68 patients, the catheter was inserted into the right internal jugular vein and in 20 patients into the left internal jugular vein (LIJV). Subclavian veins were used in five cases and femoral veins in 11 cases. Malposition of the catheter tips occurred in six patients. In all cases, the LIJV was cannulated. In two cases, the catheter tip malposition was in the right innominate vein and in four cases in the azygos vein. Our data demonstrate that with the blind insertion of tunneled hemodialysis catheters, the risk of catheter tip malposition is significantly higher with the left side insertion. As catheter insertion through the LIJV holds very high (30%) risk of the tip malposition, it should always be performed under the fluoroscopic control.

Piriformis syndrome: treatment of a rare cause of posterior hip pain with fluoroscopic-guided injection.

Piriformis syndrome involves the irritation of the piriformis muscle due to various reasons that are primarily related to anatomical variation or sciatic nerve compression due to contraction caused by overuse. In this study, we aimed to define an injection method that is easy to apply, safe, simple and repeatable. We administered percutaneous lidocaine and depomedrol injections into the hips of 28 patients (14 men and 14 women) under fluoroscopic control. Bipolar injections of the piriformis muscle were performed at the medial pole, the intersection of the sciatic notch and the sacroiliac joint, and at the lateral pole of the femoral insertion region. Each injection was 5 cc, and the contrast agent was observed after the dyeing process. Clinical examinations were performed before and 6 weeks after the injections. The average of Harris Hip Score increased from a pre-injection score of 44.5 to a post-injection score of 68.5, and the Visual Analog Scale scores decreased from 8.3 to 4.2 (p<0.05). Our findings lead to the conclusion that fluoroscopy-guided percutaneous local anaesthetic and corticosteroid injection is a simple and effective piriformis syndrome treatment that can feasibly be effectively performed by orthopaedic surgeons.

A Novel Method of Axillary Venipuncture Using the Cephalic Vein as a Sole Anatomic Landmark

The use of axillary venipuncture for pacemaker lead implantation has become a common technique. However, because of its relatively high complexity, it is still not the method of choice in most hospitals. As such, we propose an effective, simple, and safe technique for axillary venipuncture using only the cephalic vein as an anatomic landmark, with the possibility of selective cephalic contrast venography as a backup. A total of 108 patients were examined. After preparation of the cephalic vein, the puncture needle was inserted into the superficial pectoral muscle 1.5-2 cm medial to the cephalic vein and advanced in the direction parallel to the course of the cephalic vein. The needle was advanced up to 3-4 cm at an angle of 30° relative to the body surface, applying gentle suction during advancement. If after 3 attempts the axillary vein was not accessed, the same process was repeated 3-4 cm medial to the cephalic vein. If this was not effective, contrast venography of the axillary vein through the cephalic vein was performed. In 92.6% of all cases, the axillary vein was cannulated without fluoroscopic control, and in 7.4% of cases, fluoroscopic control and selective contrast venography were needed. A novel technique for axillary venipuncture using the cephalic vein as a single landmark is a simple, effective, and safe tool for pacemaker lead implantation. In some cases, selective cephalic contrast venography is an elegant and effective addition.

Ostéotomie d’accourcissement du capitatum pour les stade IIIA de maladie de Kienböck. Revue d’une série de 10 poignets avec un recul minimum de 5 ans

Treatment for Kienböck's disease is still controversial, and even more in case of positive or neutral ulnar variance. Our objective was to assess the long-term clinical and radiological outcome of capitate shortening for patients with stage IIIA disease. Between 2002 and 2008, 11 patients (10 male, 1 female) were operated on in our center. Their average age was 40 years (23 to 66), 9 were active manual workers. Dominant side was involved in 7 cases. All patients had a stage IIIA disease based on Lichtman's criteria, with a neutral or positive ulnar variance and a type I lunate according to Viegas's classification. Surgical procedure, performed under regional anesthesia, with brachial tourniquet, and fluoroscopic control, consisted of a transverse osteotomy with a 2 mm shortening of the capitate through a longitudinal dorsal approach. Fixation was carried out by one or two memory staples. A retrospective assessment was carried out by an independent observer in 2013, with clinical examination, radiological PA and lateral views. Clinical outcome measures included the QuickDASH, Modified Mayo Wrist Score (MMWS), Visual Analogue Scale (VAS) ratings of wrist/pain function, wrist motion, grip strength and patient's satisfaction. A modified Wilcoxon signed rank test was used to compare quantitative data. Only 1 patient was lost of view, follow-up ranged from 5 to 11 years (mean 8) for the 10 others patients. There was no post-operative complication, all patients has resumed their former activities except one who has received a professional reclassification. MMWS was 81.5 (70–95) and QuickDASH was 21.6 (0–47) at review but pre-operative scores were not available. The average wrist flexion/extension arc increased from 70° pre-operatively to 90° at review (P = 0.1398), average grip strength increased from 22 (50% of the contralateral side) to 36 (84%) (respectively P = 0.0078 and P = 0.0057). VAS wrist pain decreased from 7.8 (7–9) to 1.8 (0–5) (P = 0.0055). Radiographic disease progression occurred only in 2 wrist, rated stage IIIB, at 8 and 10 years follow-up without a bad clinical outcome (MMWS 90 et 80). Seven patients were very satisfied and 3 satisfied. Based upon our experience, we recommend capitate shortening for symptomatic stage IIIA disease with positive or neutral ulnar variance and Viegas's type I lunate.

&lt;i&gt;Ex Vivo&lt;/i&gt; Model for Percutaneous Vertebroplasty

The testing of novel biomaterials for percutaneous vertebroplasty depends on suitable animal models. The aim of this study was to develop ex vivo a reproducible and feasible model of percutaneous vertebroplasty, for ulterior application in vivo. A large animal model was used (Merino sheep), due to its translational properties. Vertebroplasty was performed under tactile and fluoroscopic control, through a bilateral modified parapedicular access in lumbar vertebrae (n=12). Care was taken in order to avoid disruption of the vertebral foramen. The average defect volume was 1234±240 mm3. This mean volume ensures practical defects to test novel injectable biomaterials. 6 vertebrae were injected with a commercial cement (Cerament®, Bone Support, Sweden). Adequate defect filling was observed in all vertebrae. All vertebrae were assessed by microCT, prior to and post defect creation and after biomaterial injection. All vertebrae were mechanical tested. No mechanical failure was observed under loads higher than the physiological. Ultimately, this model is considered suitable for pre-clinical in vivo studies, mimicking clinical application.

A study of biplanar crossed pin construct in the management of displaced pediatric supracondylar humeral fractures.

PurposeStudy of a biplanar crossed pin construct by two crossed Kirschner wires in the management of displaced extension type supracondylar humeral fractures in children.MethodsSixty-four patients with such fractures were included and treated according to the study protocol: after achieving closed reduction under general anesthesia with fluoroscopic control, two crossed Kirschner wires of equal diameter were inserted percutaneously. The first lateral wire tracts from the posterolateral corner of the epicondyle to the anteromedial cortex proximally. Then, the medial wire is inserted from the anteromedial corner of the epicondyle to the posterolateral cortex proximally after crossing the fracture site. Thus, a biplanar crossed pin construct was achieved, as each wire had two separate fixation points and the crossed construct was achieved not only in the coronal plane but also in the sagittal plane. Every effort was made to get this construct right at the very first attempt without repetition.ResultsTwo patients were lost to follow-up during the first postoperative year. The mean follow-up for the remaining 62 patients was 14.5 months (range 6–24 months). At the final follow-up, using Flynn’s overall modified classification, the clinical result was considered to be satisfactory in 60 (96.8 %) patients and unsatisfactory with poor result in two (3.2 %) patients. Technical error was thought to be the cause of the poor results. There were no postoperative neural or vascular complications.ConclusionA biplanar crossed pin construct achieved by two Kirschner wires crossed in the coronal and sagittal planes is efficient to stabilize a displaced extension type supracondylar fracture of the humerus in children.

Open microsurgical tumor excavation and vertebroplasty for metastatic destruction of the second cervical vertebra—outcome in seven cases

Background contextMetastatic osteolytic involvement of the second cervical vertebra (C2) is rare, but usually very painful. Percutaneous vertebroplasty has shown to be effective regarding pain control, but carries the risk of cement leakage. PurposeTo describe an alternative microsurgical procedure suitable for patients suffering from C2 osteolysis who are considered to be high risk with respect to cement leakage. Study designA technical report. Patient sampleIt included seven patients. Outcome measuresThey include the assessment of clinical safety regarding approach- and procedure-related morbidity and radiologic safety regarding extravertebral cement leakage and the assessment of clinical efficacy by monitoring the pain activity using the visual analog scale (VAS). Materials and methodsSeven patients (five men, two women; mean age 70 years) presented with an acute onset of excruciating neck pain (VAS>6) due to osteolytic destruction of the axis vertebra. There was no neurologic deficit and no compression of the spinal cord preoperatively requiring surgical decompression or stabilization in any of the cases. An open treatment strategy via an anterolateral microsurgical approach was performed. Under biplanar fluoroscopic control, the soft tumor tissue was resected out of the vertebral body through a drilled entry in the anterior wall. After the excavation procedure, the resection cavity was filled with minimal pressure with polymethylmethacrylate bone cement. ResultsAll patients suffered from severe spontaneous neck pain (mean VAS 8.1, range 6–9), with head motion-dependent pain exacerbation despite high dose of opiates and fixation of the head with a brace.Mean duration of the operative procedure was 51 minutes. Histologic analysis revealed a diagnosis of cancer metastasis in all cases. On average, 1.9 mL cement was placed within the vertebral body, and no cement leakage was observed in postoperative computed tomography and X-ray controls. All patients experienced immediate pain relief at Day 1 after the procedure (mean VAS 4.0, range 2–6), and a further decrease of pain levels was observed at Week 6 after the completion of radiation therapy (mean VAS 2.0, range 0–5). ConclusionsIn cases of metastatic C2 destruction, tumor excavation via an anterolateral approach and subsequent filling of the resection cavity with bone cement offers a safe and effective alternative to percutaneous approaches.

Vertebral augmentation for neoplastic lesions with posterior wall erosion and epidural mass.

The presence of a cortical erosion of the posterior wall or an epidural mass is commonly considered a contraindication to performing a vertebral augmentation, considering the perceived increased risk of an epidural cement leak. Our aim was to assess technical and clinical complications of vertebral augmentation procedures performed for pain palliation and/or stabilization of neoplastic lytic vertebral body lesions, with cortical erosion of the posterior wall, often associated with a soft-tissue epidural mass. In 48 patients, we performed retrospective vertebral augmentation assessment on 70 consecutive levels with cortical erosion of the posterior wall, as demonstrated by preprocedural CT/MR imaging. An epidural mass was present in 31/70 (44.3%) levels. Cavity creation was performed with Coblation Wands before cement injection in 59/70 levels. Injection of high-viscosity polymethylmethacrylate was performed under real-time continuous fluoroscopic control. Postprocedural CT of the treated levels was performed in all cases. Clinical follow-up was performed at 1 and 4 weeks postprocedurally. In 65/70 (92.8%) levels, the vertebral augmentation resulted in satisfactory polymethylmethacrylate filling of the lytic cavity and adjacent trabecular spaces in the anterior half of the vertebral body. An epidural leak of polymethylmethacrylate occurred in 10/70 (14.2%) levels, causing radicular pain in 3 patients, which spontaneously resolved within 1 week in 2 patients, while 1 patient with a T1-T2 foraminal leak developed severe weakness of the intrinsic hand muscles and a permanent motor deficit. In our series of vertebral augmentation of neoplastic lytic vertebral lesions performed for palliation of pain and/or stabilization, we observed a polymethylmethacrylate epidural leak in only 14.2% of levels, despite the presence of cortical erosion of the posterior wall and an epidural mass, with an extremely low rate of clinical complications. Our data seem to justify use of vertebral augmentation in patients with intractable pain or those at risk for vertebral collapse.

Patients Prefer the Use of a Patient Decision-Making Aid When Discussing Surgical Options for Nephrolithiasis

METHODS: The magnetic Blackstar DJ is a 7 french ureteral stent with a small magnet fixed with a string at the distal DJ loop. To remove the DJ a customized catheter with a magnetic Tiemann tip is used. The catheter is inserted after transurethral application of a standard lubricant and removed with the DJ after getting in contact with the DJ’s magnet. The study was approved by local ethics committee. We placed the magnetic DJ in 20 consecutive patients after ureteroscopy for stone removal. No additional foley catheter was placed. The DJ was removed the next day with the magnetic retrieval catheter either by a physician or a nurse. Retrieval time, patient comfort and feasibility of the retrieval device were assessed. RESULTS: The DJ could be removed with the retrieval device within less than 30 seconds in 19 out of 20 patients. In the first patient the removal was not successful due to an enlarged prostate middle lobe. For this patient a cystoscopical removal was needed. In the second patient the removal was performed under fluoroscopic control to ensure save handling of the retrieval device by the surgeon. In all other patients the removal of the catheter was performed in the patients room on the ward. CONCLUSIONS: The removal of the magnetic DJ using the retrieval device is fast and easy and can be performed by physicians as well as nurses. The patients didn’t complain about a lot of discomfort during the removal. This technique might lead to significant cost reduction compared to the standard cystoscopical removal of ureter stents with sterile instruments in the endourological operation room. Our feasibility study indicates this magnetic DJ to significantly reduce patient’s discomfort by DJ removal and therefore seems to be a promising new device for endourologists.

OC-072 Use Of A Novel Self-expanding Metal Stent To Allow For Endoscopic Drainage And Necrosectomy Of Pancreatic Fluid Collections

IntroductionPost-inflammatory peri-pancreatic fluid collections are frequent sequelae of severe acute pancreatitis. Collections are at risk of suppurative infection complicated by pancreatic necrosis. Over the last decade there has been an...

Zirconia-containing radiopaque mesoporous bioactive glasses

A radiopaque mesoporous bioactive glass (named MBGZ-7) was obtained through a combined sol–gel and evaporation induced self-assembling (EISA) route, adding zirconium propoxide to the synthesis batch as the zirconia precursor. The nitrogen sorption analysis confirmed the mesoporous nature of the glass. The assessment of in vitro bioactivity by soaking in acellular simulated body fluid (SBF) and SEM observation showed the deposition of hydroxyapatite crystals on its surface after one week. The good radiopacity level was demonstrated by comparing X-ray images of MBGZ-7 and a blank sample that did not contain radiopaque additives. It is envisaged the use of MBGZ-7 as a promising dispersed phase in composite materials for minimally invasive surgery procedures, such as injectable bone cements, in order to allow the visualization of the implant under fluoroscopic control, during both injection and follow-up.

Su1696 The Effect of Endoscopist Control of Fluoroscopy on Cannulation Rate and Fluoroscopy Time During ERCP Training

Su1696 The Effect of Endoscopist Control of Fluoroscopy on Cannulation Rate and Fluoroscopy Time During ERCP Training

Trans-Abdominal Ultrasound Guided ERC in a Pregnant Woman With Bile Duct Stones

BackgroundThe change in lithogenicity of bile, increased stasis of bile and decreased gall bladder emptying are the possible reasons for an increased risk of gall stones during pregnancy. However, biliary interventions during pregnancy are associated with risks to both the pregnancy and developing fetus. ERC under fluoroscopic control as gold standard is associated with higher risk of premature labor and teratogenity. Methods and patientWe performed transabdominal ultra-sound guided ERC in one patient in the second trimenon with gall stones. While the hilus area is observed by ultrasound, the papilla is carefully cannulated with a guidewire. A contrast agent is applied in the common bile duct (CBD) via the guide-wire of conventional duodenoscope. ResultsA rather small stone obstructing the common bile duct was visualized. To keep the invasiveness of this procedure to an absolute minimum at this time sphincterotomy with subsequent stone extraction were postponed after delivery and we decided to decompress the bile duct with a plastic stent. There were no complications due to the procedure. Bile flow was observed. ConclusionThe exposure to radiation raises a problem in pregnant women because radiation is a possible risk for fetal disorders or premature labor, depending of the trimenon. For pregnant patients with symptomatic obstruction current guidelines recommend treatment by ERCP but with minimal exposure to radiation. This case report demonstrates a feasible alternative without fluoroscopy to the conventional fluoroscopic ERC in pregnant woman.

Current concepts in diagnosis and treatment of venous malformations

IntroductionVenous malformations are the most common type of vascular malformation, usually detected at birth or during puberty. By occurring during human growth or through localized trauma, pain, functional impairment and aesthetic disfigurement is often observed.Ultrasonography, Doppler flow Imaging, and Magnetic Resonance Imaging are the most informative techniques which reveal the extent of tissue involvement and differentiate between high and low flow anomalies. Therapeutic options for treatment of venous malformations are sclerotherapy with alcohol, ethoxysclerol and bleomycin, laser therapy (Nd:YAG), surgery and combined therapeutic modalities. The aim of percutaneous sclerotherapy is the successive reduction of the volume of the lesion by aseptic inflammation. Patients and methodsThis is a review of 51 patients with venous malformation treated by the Interdisciplinary Center for Vascular Anomalies at the University Hospital Tübingen, (Germany), from July, 2002 until January, 2007. The mean age of first consultation in our outpatient department was 26.4 years (median).12 patients were treated by sclerotherapy with highly concentrated alcohol, 9 by surgery, and 7 by laser therapy. In some cases we combined different treatments. 9 patients had only sclerotherapy, while 3 had a combination of pre-operative sclerotherapy and surgery. ResultsWe obtained positive results in patients treated with sclerotherapy and combined sclerotherapy and surgery. ConclusionSclerotherapy is safe (under fluoroscopic control), efficient, and can be repeated multiple times. Therefore, it should be considered as first-line treatment in venous malformations. A combination of a sclerotherapy with surgery is also useful in many cases.

PD37-11 BLACK-STAR® - MAGNETIC DJ REMOVAL

You have accessJournal of UrologyStone Disease: New Technology II1 Apr 2014PD37-11 BLACK-STAR® - MAGNETIC DJ REMOVAL Marie-Claire Rassweiler, Maurice-Stephan Michel, and Manuel Ritter Marie-Claire RassweilerMarie-Claire Rassweiler More articles by this author , Maurice-Stephan MichelMaurice-Stephan Michel More articles by this author , and Manuel RitterManuel Ritter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2029AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral stenting is a common procedure in endourology. One routine indication is after ureteroscopic stone extraction if small urothelial lesions occured. The cystoscopic removal of a ureteral stent can cause unpleasant side effects, such as urinary frequency, urgency, incontinence, haematuria, bladder pain and flank pain, which have a negative impact on a patient's life. It is necessary to minimize the pain during stent removal in order to increase the patient’s quality of life. Therefore we prospectively assessed the feasibility of a newly developed ureter stent (DJ) with a small magnet at its distal end (Magnetic Black Star, Urotech (Achenmühle, Germany) and a customized magnetic retrieval catheter. METHODS The magnetic Blackstar DJ is a 7 french ureteral stent with a small magnet fixed with a string at the distal DJ loop. To remove the DJ a customized catheter with a magnetic Tiemann tip is used. The catheter is inserted after transurethral application of a standard lubricant and removed with the DJ after getting in contact with the DJ’s magnet. The study was approved by local ethics committee. We placed the magnetic DJ in 20 consecutive patients after ureteroscopy for stone removal. No additional foley catheter was placed. The DJ was removed the next day with the magnetic retrieval catheter either by a physician or a nurse. Retrieval time, patient comfort and feasibility of the retrieval device were assessed. RESULTS The DJ could be removed with the retrieval device within less than 30 seconds in 19 out of 20 patients. In the first patient the removal was not successful due to an enlarged prostate middle lobe. For this patient a cystoscopical removal was needed. In the second patient the removal was performed under fluoroscopic control to ensure save handling of the retrieval device by the surgeon. In all other patients the removal of the catheter was performed in the patients room on the ward. CONCLUSIONS The removal of the magnetic DJ using the retrieval device is fast and easy and can be performed by physicians as well as nurses. The patients didn’t complain about a lot of discomfort during the removal. This technique might lead to significant cost reduction compared to the standard cystoscopical removal of ureter stents with sterile instruments in the endourological operation room. Our feasibility study indicates this magnetic DJ to significantly reduce patient’s discomfort by DJ removal and therefore seems to be a promising new device for endourologists. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e949-e950 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marie-Claire Rassweiler More articles by this author Maurice-Stephan Michel More articles by this author Manuel Ritter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Modelling the air mass transfer in a healthy and a stented rabbit trachea: CT-images, computer simulations and experimental study

Endotracheal stenting is a controversial treatment for tracheal stenosis. Metallic stents have advantages but also show disadvantages such as restenosis due to epithelial hyperplasia and granuloma formation. In this work we analyze the response of a rabbit tracheal wall during normal breathing under implantation of a Zilver® Flex™ Stent. Trachea geometries were reconstructed using medical images for both healthy and stented rabbit. The numerical model was used for analyzing tracheal stresses before and after prosthesis implantation using a fluid–structure interaction approach (FSI). Unstructured tetrahedral-based grids were used to perform the simulations with a finite element-based commercial software code. Experimental tests on rabbit trachea samples were performed in order to get the material property constants. Deformations of the tracheal cartilage rings and of the muscular membrane as well as the maximum principal stresses of the tracheal wall were analyzed and compared with those of the healthy trachea in absence of prosthesis. In addition, an experimental validation of the model was provided. The prosthesis was percutaneously implanted under fluoroscopic control. Period of the study was 90days. The tracheal wall response was assessed by means of computerized tomography by endoscopy, macroscopic findings and histopathological study. Experimentally revealed tissue damages due to the stent were then compared with numerical results. Interesting correlation with maximal principal stresses and induced wall shear stress were found in the same region.

Minimal invasive para-rectus approach for limited open reduction and percutaneous fixation of displaced acetabular fractures

IntroductionMinimal invasive fixation has been reported as an alternative option for treatment of acetabular fractures to avoid blood loss and complications of extensive approaches. Closed reduction and percutaneous lag screw fixation can be done in minimally displaced acetabular fractures. Open reduction is indicated, if there is wide displacement. In this study, we report the use of a mini-open anterior approach to manipulate and reduce anteriorly displaced transverse acetabular fractures combined with percutaneous lag screw fixation. MethodsThis report included eight patients. All had anterior displaced simple transverse acetabular fractures. An oblique mini-incision was made above and medial to the mid-inguinal point, and lateral to the lateral border of rectus abdominis muscle. The external abdominal oblique aponeurosis was incised along its fibres. The arched fibres of internal abdominal oblique were displaced medially above the inguinal ligament to expose and incise the fascia transversalis. Care was taken to avoid injury of ilioinguinal nerve, inferior epigastric vessels, and spermatic cord. The external iliac vessels were palpated and protected laterally. A blunt long bone impactor was introduced through this small incision to manipulate and reduce the fracture under fluoroscopic control. Fluoroscopic guided percutaneous lag screw fixation was done in all patients. ResultsThe average time to operation was 4 days. Average blood loss was 110mL. Operative time averaged 95min. Maximum fracture displacement averaged 10mm preoperatively and 1.3mm postoperatively. According to Matta score, anatomical reduction of the fracture was achieved in five patients and imperfect in three. Follow up averaged 27 months. Wound healing occurred without complications and fracture union was achieved without secondary displacement in all patients. Average time to fracture healing was 14 weeks. According to the modified Merle d’Aubigné score, functional outcome was good to excellent in all patients. Discussion and conclusionLimited open reduction can solve the problem of fracture reduction, which is the main concern in minimal invasive fixation of acetabular fractures. It may help the inclusion of displaced acetabular fractures for percutaneous lag screw fixation. This mini-para-rectus approach has the advantages of minimal soft tissue dissection with the possible anatomical reduction of simple transverse displaced acetabular fractures.

Wireless Blood Pressure Monitoring with a Novel Implantable Device: Long-Term In Vivo Results

Devices constantly tracking the blood pressure (BP) of hypertensive patients are highly desired to facilitate effective patient management and to reduce hospitalization. We report on experiences gathered in a pilot study that was designed to evaluate the prototype of a newly developed, minimally invasive implantable sensor system for long-term BP monitoring. The device was implanted in the femoral artery (FA) of 12 sheep via standard FA catheterization under fluoroscopic control. Accuracy of the recorded blood pressure was determined by comparison with a reference catheter, which was positioned in the contralateral FA immediately after implantation. Regular follow-up included angiography, computed tomography (CT), and control of functionality and position of the BP sensor. Animals were euthanized after 6 months. FA segments with in situ pressure sensor underwent macroscopic and histopathologic examinations. All implantations of the novel sensor device in the FA were successful and uneventful. High-quality BP recordings were documented. Bland-Altman plots indicate very good agreement. Comparison with measurements taken from the reference sensor revealed mean differences and standard deviations of -0.56 ± 0.85, 0.29 ± 1.44, and 0.85 ± 2.27 mmHg (diastolic, systolic, and pulse pressure, respectively) after exclusion of one outlier. CT uncovered deficiencies in cable stability that were addressed in a redesign. No thrombus formation, necrosis, or apoptosis were detected. The pilot study proved the technical feasibility of wireless BP measurement in the FA via a novel miniature sensor device.

Outcomes after stenting for malignant large bowel obstruction without radiologist support

To assess outcomes after colonic stent insertion for obstructing colorectal malignancies performed by an endoscopist without radiologist support. This is a retrospective study of all stents inserted by a single surgeon in a District General Hospital over an eight year period. All stents were inserted for patients with acute large bowel obstruction secondary to a malignant colorectal pathology either for palliation or as a bridge to surgery. Procedures were performed by a single surgeon endoscopically with fluoroscopic control in the X-ray department but without the support of an interventional radiologist. Data was collected prospectively on a pre-designed database. The indication for all stent procedures was an obstructing colorectal malignancy. Out of 53 patients, the overall success rate was 90.6%. Eight patients had a stent intended as a bridge to surgery and 45 as a palliative procedure. Technical success was achieved in 50 out of 53 procedures (94.3%) and clinical success in 48 of those remaining 50 (96.0%). Those with unsuccessful technical or clinical procedures went on to have defunctioning stomas to treat their obstruction. There were six complications from the technically successful stents (12.0%). These included one migration, one persisting obstructive symptoms and four cases of tumour overgrowth of the stents at a later date. Haemorrhagic complications, perforation or mortality were not observed in our series. Our results are comparable to several other studies assessing stent outcomes for obstructing bowel cancer. Our data suggests that colorectal stents can be inserted without radiologist support by an adequately trained individual with good outcomes.

Metallic stent in the endoscopic treatment of pancreatic fluid collections

The endoscopic treatment of pancreatic fluid collections (PFCs) has become the preferred first-line approach. Fully covered self-expandable metal stents (FCSEMS) were considered as an alternative to multiple double pigtail stents. The aim of this study was to evaluate the results of the endosonography guided drainage (EUS-GD) of PFCs with FCEMS. A total of 33 consecutive patients were included. Cystogastrostomy and cystoduodenostomy were created with a linear echoendoscope under endosonographic and fluoroscopic control. Procedures were performed in a standard way of, puncture with a 19 gauge needle, bougie dilation and insertion of FCSEMS. A total of 33 patients (mean age 52 years, 21 men, range: 18-77 years), were included. PFCs were 22 non-infected symptomatic pseudocyst and 11 walled-off necrosis or abscess. EUS-GD was successful in 30 (90.9%) patients. Stent insertion failed in one patient. Two patients needed surgery. Complications were observed in 8 (25%) patients (stent dislocation in 3, perforation in 2, bleeding in 2 and pneumoperitoneum in 1 patient). Procedure related mortality was not seen. The mean cyst size was 11.3 cm (5-22). FCSEMS were successful in the treatment of pseudocysts (after 1 month mean cyst size is 6.2 cm, range: 0-15 cm, with 54.8% decrement rate). During a mean follow-up of 15 months complete resolution was 66.6% (20 patients) and recurrence due to stent malfunction was 10%. All these cases were submitted to a new session of endoscopic drainage. EUS-GD, FCSEMS insertion provides an effective, minimally invasive, and safe approach in the management of PFCs.